Fscig Hyqvia denied as duplicate or overlapping therapy by Cigna?

Cigna's specific coverage criteria for fscig hyqvia are defined in its own published medical/coverage policy and the FDA-approved prescribing label. A successful appeal documents that your medical records satisfy each criterion those sources list — confirmed diagnosis, any required prior treatments (with dates and outcomes), and clinical severity. If the exact criteria weren't included with your denial, request them in writing; your appeal then maps each requirement to the matching fact in your chart.

## Why Cigna Denies HyQvia as Duplicate Therapy

HyQvia is a subcutaneous immunoglobulin (SCIG) product that combines human immunoglobulin with recombinant human hyaluronidase to enable high-volume, low-frequency infusion under the skin. Cigna's "duplicate therapy" denial arises when the plan's system identifies that the patient is already receiving or has recently received another immunoglobulin product — typically intravenous immunoglobulin (IVIG) or a different SCIG formulation. Cigna treats simultaneous or overlapping immunoglobulin authorizations as duplicative, even when the route of administration, frequency, or tolerability profile differs meaningfully.

## Why This Denial Is Appealable

A duplicate-therapy denial is not a clinical judgment that HyQvia is ineffective — it is an administrative rule designed to prevent concurrent billing for the same pharmacological class. If your prescriber is transitioning you from IVIG to HyQvia, or replacing a less tolerable SCIG product, the clinical record will show a clear rationale for the switch rather than a duplication. The appeal re-frames the request as a therapy transition or clinically indicated substitution, not an addition.

## Federal Appeal Framework

• Internal appeal: Under ERISA §503 and ACA §2719, you have the right to a full-and-fair internal review. File within the deadline on your denial notice and request the specific duplicate identified by Cigna.
• External review: Available after internal exhaustion; approximately four months under federal rules. Particularly valuable when the treating immunologist's clinical reasoning was not captured in the original submission.
• Expedited review: Available if immunodeficiency-related complications make delay dangerous.

## Documentation to Gather

1. Therapy transition documentation — prescriber note explaining that HyQvia is intended to replace, not supplement, the previously authorized immunoglobulin product, with the clinical reason for the change. 2. Prior product tolerability record — documentation of adverse reactions, infusion difficulties, or quality-of-life limitations with the prior immunoglobulin that motivated the switch. 3. Diagnosis and immunoglobulin deficiency records — immunology lab results confirming the underlying condition and the clinical basis for immunoglobulin replacement therapy. 4. Prescriber medical-necessity letter — a letter from your immunologist distinguishing HyQvia from the prior product and explaining why the transition is medically necessary for your individual case.

## Criteria-Mapping Structure

Request from Cigna the specific product they identified as the duplicate and the policy language defining duplicate therapy. In your appeal, show that HyQvia and the prior product will not be administered concurrently, that the prior authorization is being replaced rather than supplemented, and that the clinical record supports the transition. A side-by-side table showing old vs. new product with dates and rationale is the clearest format.